The present invention relates generally to an attachment integrated claims (AIC) system for preparing and processing forms with integrated attachments. More specifically, the present invention relates to a Customizable Claim Form, i.e., a Dynamic Claim Form (DCF) suitable for use with an AIC system. A method of operating a totally digital AIC system while employing a DCF is also disclosed.
High administrative costs for filing and processing health insurance claims have been the bane of the health insurance industry from its inception. Over the years, many attempts have been made to develop a faster and more cost effective claims processing system. Three stages in this development effort are described in the following correspondingly numbered paragraphs.
(1) The original system involved hard copy paper claims only, with transmission and all processing done manually. Originally, an insurance claim was filed by the patient or the health care provider filling out a paper form. The completed paper form was then mailed to the insurance company. At the insurance company, the paper claim form went through a series of administrative steps, all the time remaining as a hard copy paper object. When a decision was made, the decision was written up and archived with the claim form; a hard copy was also sent to the patient and/or provider along with the payment.
(2) The first significant advancement resulted from the introduction of the mainframe computer. This allowed for electronic processing within a given insurance company, i.e., once the claim was on the computer inside the company, the paper form could be dispensed with. Computerization is a highly effective way of reducing administrative overhead in claims processing.
Thus, mainframe computers were purchased and installed internally at the insurance companies. Since these computers were intended for internal use only, each company thought only of its own needs and either developed proprietary claims processing software or had claims management software purchased from an outside source customized to meet the insurance company""s claims processing methodology. While the claims management software for a number of insurance companies would be written in the same high-level programming language, e.g., COBOL, the similarity between software programs often ended there.
There were many virtues to these early systems, primarily with respect to decreased administrative costs, but a major drawback was that the data for each xe2x80x9cpaperxe2x80x9d claim had to be entered into the computer to form an electronic claim. This necessitated the manual transcription of exactly the same information that had been entered into the original paper claim before it was sent to the insurance company.
(3) The next advancement was the electronic filing of claim forms. This was made possible by the introduction of the personal computer and modem into the provider""s office. The main purpose of this stage was to eliminate the manual re-entry of information into the insurance company mainframe.
The basic idea was to have the providers fill out an electronic claim form, instead of a paper claim form. This electronic form, which would be stored in the memory of their PCs, would then be transmitted, as a computer file, to the insurance company. It could then be integrated directly into the electronic claims processing system without the manual re-entry of data. Thus, the technology existed to produce a system that computerized the overall filing and processing of the insurance claim from the point of entry, the provider""s office, to the final report of the claims adjuster.
Although the idea was straightforward, implementation was not. Two basic problems had to be overcome in order to create a viable system. First, the information contained in the electronic claim form had to be integrated into the claims processing software at the insurance company. Second, a majority of providers have to be able to interface with a majority of insurance companies, i.e., insurance company mainframe computers. However, because of the way computers were introduced into the insurance industry originally (stage #2), there was no industry-wide standard, i.e., the legacy mainframe computers of the different insurance companies were incompatible. This was true both with respect to the type of software used and with respect to the information that each company required on its claim form.
One attempt to deal with these problems was the creation, by a consortium of insurance companies, of the National Electronic Information Corporation (NEIC). NEIC""s basic function is that of a clearinghouse. It acts as a common interface between the insurance companies and the service providers. It also establishes rigid standards that must be met in order to transmit an electronic claim form to an insurance company. In practice, the service provider sends an electronic claim to a vendor, who performs a service such as screening of the form. The vendor then transmits the form to NEIC, which then re-transmits it to the patient""s insurance company. Since it is a computer file, the information in the electronic claim form can then be entered directly into the company""s mainframe claims processing system, without the manual re-entry of data, and then processed.
Thus, a coherent system was created that allows for the electronic filing, transmission, and processing of insurance claims. This system is employed by thousands of providers and hundreds of insurance companies.
NEIC was designed to act as a clearinghouse for claims that are 100% text and that conform to very restrictive formats. For claims that meet these conditions it functions well, resulting in substantial savings on administrative costs for the insurance companies. It has been estimated that going to this third stage system results in savings of as much as 60% in claims processing costs.
However, there are many claims that do not meet these conditions. These would include claims that require additional text information that does not fit into the prescribed format and/or claims that require non-text information. In general, these are called xe2x80x9cclaims with attachments.xe2x80x9d xe2x80x9cAttachmentsxe2x80x9d are any additional information that must be sent with the xe2x80x9cstandard text claim form.xe2x80x9d This could include: pictures, graphs, additional text not allowed on the standard claim form, sound recordings, etc.
An example of such a claim would be the PAC (Prior Approval Claim), which is may be alternately denoted as a xe2x80x9cPretreatment Claim.xe2x80x9d These are claims that are sent to the insurance carrier before a procedure is performed. For example, pretreatment claims are often required by dental insurance companies on any procedure over a specified amount, e.g., $200. The aspect of this type of claim which renders it incompatible with the present electronic claim processing system is that the insurance companies require that additional medical evidence be included, i.e., attached to, the text part of the claim form. In an exemplary case, the additional medical evidence is an x-ray.
The goal of the insurance company is to review the claim, i.e., both the text form and attachment, and to do so in a cost-effective manner. The natural next stage in the development of claims processing systems is to attempt to computerized this process.
Scanners are now available that can digitize a dental x-ray, i.e., convert it into a computer file that can be viewed on a monitor. Nevertheless, transforming the medical evidence into digital form is not enough to facilitate electronic processing of claims with attachments. One must also take into consideration the existing claims processing infrastructure, i.e., the legacy infrastructure.
The difficulty with trying to include a digitized x-ray for processing with an electronic claim form, within the current infrastructure, is multifaceted. First, NEIC does not at the present time allow this type of information to be transmitted through NEIC to the insurance companies. Second, with the current system, the claims adjusters access claims information through terminals connected to mainframes. However, there is the inherent problem of displaying images on mainframe computers. This is especially true of mainframe computers running software written in business programming languages such as COBOL. It might be thought that a solution to this problem would be to replace the terminal with a PC. Although many personal computers provide the graphics support needed to display the digitized x-ray, there are significant problems in interfacing a PC with a mainframe computer. For example, in order to interface with the mainframe computer, PCs often run terminal emulation software that permits the PC to act like a dedicated, dumb terminal attached to the mainframe computer. Terminal emulation software is notoriously lacking in graphics capability. Finally, getting a digitized x-ray from one provider to one insurance company is not all that is needed. Rather, what is really needed is an industry-wide system by which a provider can interact with any insurance company. This results in a massive interfacing problem since there are multitudes of insurance companies using different legacy hardware systems and company unique software.
Each time a way has been found to more fully utilize computers in claims processing systems, the administrative costs associated with claims processing have gone down. However, in the area of xe2x80x9cclaims with attachments,xe2x80x9d no coherent industry-wide system exists that allows for the integrated filing, transmitting and processing of these claims electronically, i.e., via computers. Thus, when attachments are required, providers are forced to submit hard copy claim applications, while insurance companies labor under an administrative system that is a hybrid between a manual and an electronic system, i.e., a hybrid between stage #1 and stage #2. This hybrid system, which is described in greater detail below, is labor intensive, prone to problems, and slow. For providers, insurance companies, and patients, this is a time-consuming, costly and irritating process.
In short, there is at least one type of insurance claim that has not, until now, been able to avail itself of the third stage of computerization, as described above. In fact, there are even difficulties with the second stage. This group includes any claim whose xe2x80x9cstandard text formxe2x80x9d must be accompanied by additional information that does not fit into this standard format, e.g., x-rays, EKGs, additional text information such as Operating Room Reports, etc. In general, these are referred to as xe2x80x9cattachments.xe2x80x9d One primary example of this would be Prior Approvals for dental procedures. Prior Approval Claim (PAC) applications are those claims that are submitted for the purpose of receiving a predetermination of benefits from the insurance company for a procedure that has not as yet been performed.
In the area of Prior Approval Claims, the goals of the insurance companies are to validate the necessity of the procedure and to determine whether the patient""s insurance policy obligates the insurance company to pay for such a procedure. This requires that the insurance company itself review the medical evidence. For an insurance company""s in-house dentist, for example, to make this appraisal, the dentist is required to review both the xe2x80x9ctext formxe2x80x9d and the accompanying x-ray of the patient. However, the presence of a film x-ray means that electronic claims methods cannot be implemented. The savings associated with electronic claim processing is not available with respect to Prior Approval Claim forms.
Nationwide, there are approximately 200,000 dental PACs filed per week. Roughly, for every PAC application there will be eventually a Final Payment claim (FPC) submitted when the medical procedure is completed. It is estimated that the overall administrative cost is $25 per PAC form and $10 for the Final Payment Claim. It is also estimated that if a coherent electronic system could be implemented, it would reduce these administrative costs to $15 per PAC and $5 per Final Payment Claim. The savings could amount to as much as $3,000,000 per week collectively for the health care industry for dental PACs and FPCs alone.
An example of a hybrid system of claim processing currently in use will now be described with reference to FIGS. 1, 2A and 2B.
Referring first to FIG. 1, the U.S. Postal Service, denoted as 100, connects the service provider""s office 200 with the insurance company 300. It will be appreciated that, since PAC form handling is entirely manual at location 200, the service provider""s office is depicted as lacking computer equipment. In contrast, the insurance company typically has at least one mainframe computer 350 to which terminals 351, 352 on the respective reviewing dentist""s and claims adjuster""s desks are connected. It should also be noted that the mail room 320 is charged with a variety of tasks associated with the incoming and outgoing correspondence, as discussed in greater detail below.
As will be appreciated from FIG. 1, a paper PAC form is filled out by the patient and/or the provider and, along with the substantiating x-ray, is mailed to the patient""s insurance company. Upon entering the mail room of the insurance company, the PAC form is assigned a document identification number (DIN) and the data from the PAC form is then entered into the company""s mainframe computer. This same DIN is affixed to the x-ray. The x-ray is then manually delivered to the reviewing dentist.
By using the DIN on the x-ray, the reviewing dentist downloads, from the mainframe computer, the textual part of the patient""s PAC application. The dentist makes a decision, records it in the memory of the mainframe computer, and has a hard copy of the Predetermination form posted back to the provider. Once the procedure has been completed, the provider""s office completes the Predetermination form, or fills out a separate Final Payment Claim (FPC) form. This is then posted to the insurance company. A chronological, detailed, step-by-step description of the hybrid system will now be provided with reference to FIGS. 1, 2A and 2B.
During step S1, the dentist decides that a costly procedure is necessary for a patient whose insurance carrier requires prior approval for such treatment. During step S2, the dentist provides the patient with his diagnosis and gives the patient an estimate for performing the recommended procedure. The dentist then asks the patient to contact his insurance carrier, or plan administrator at work, to obtain the necessary PAC form. During step S3, the patient completes that portion of the PAC form that pertains to him, signs the form, and sends it to his provider.
After the PAC form arrives at the provider""s office at step S4, one of the office personnel retrieves the patient""s file and the PAC form at step S5, extracts the patient""s x-ray, either the original, a copy of the original, or a second, previously taken x-ray, during step S6, and the PAC form is filled out entirely by hand, i.e., the information about the provider has to be entered every time a new PAC form is received, during step S7. Copies of the completed form are made and are placed in the patient""s file during step S8. The envelope containing the PAC form is addressed to the appropriate insurance company at step S9. The form and the x-rays are placed in the envelope during step S10. An entry is made in both the patient""s computer file (if the provider""s office is equipped with one) and his hard copy file indicating that the PAC form has been sent during step S11 and, finally, during step S12, the envelope is mailed. See task T1 in FIG. 1.
The envelope meanders through the U.S. Postal Service 100 for several days at step S13 until the envelope finally arrives at the mail room 320 of the insurance company 300 at step S14. In the mail room, the envelope is opened (step S15), the data from the PAC form is entered into the insurance company""s mainframe computer 350 and is given a Document Identification Number (DIN) that identifies the patient and the current claim application (step S16). See task T2 in FIG. 1. During step S17, the x-ray is labeled with the same DIN. It will be appreciated that the DIN on the x-ray and in the document now on the mainframe computer must be identical. It will also be appreciated that for some insurance companies, this manual processing is contracted to an outside agency, which would require several more steps, which steps will not be described further.
During step S18, the x-ray is manually forwarded to the reviewing dentist""s area. See task T3 in FIG. 1. During step S19, the PAC form is transferred to a directory and waits to be read by a reviewing dentist.
During step S20, a group of x-rays arrives from the mail room at the reviewing dentist""s area. A film x-ray is pulled out of the waiting pile by the dentist during step S21 and the reviewing dentist then accesses the xe2x80x9cPAC formxe2x80x9d directory during step S22 by, for example, reading the DIN from the x-ray and typing the DIN into the computer. The electronic PAC form corresponding to this x-ray is located in memory and downloaded to the reviewing dentist""s monitor during step S23.
The procedure requested is read off the terminal monitor and the film x-ray is reviewed during step S24 and a determination is made during step S25. It will be appreciated that a determination refers to either an approval or a denial of the request. Assuming that the procedure is approved, a statement (or explanation) of benefits (EOB) is also generated. For the purposes of this discussion, it will be assumed that the procedure is approved; a denial would necessitate a parallel but alternative set of processing steps, which steps will not be further described. During step S26, the insurance company""s Predetermination form is filled out either electronically or by hand. For an electronic Predetermination form, the form is saved to the memory of the insurance company""s mainframe computer during step S27. The x-ray is returned to the mail room during step S28. See task T4 in FIG. 1.
Following approval, a paper copy of the Predetermination form is made during step S29. See task T5 in FIG. 1. An envelope is then addressed to the referring dentist and the Predetermination form is placed in the envelope during step S30. During step S31, the corresponding x-ray is matched with the Predetermination form and, during step S32, the corresponding x-rays are placed in the envelope. The envelope then goes back into the U.S. Postal System 100 during step S33. See task T6 in FIG. 1.
Some days later, the envelope finally arrives at the dentist""s office 200 and is opened during step S34. The results are noted in both the patient""s paper file and computer file during step S35, the x-rays are returned to the patient""s paper file at step S36, and the patient is notified of the approval and a date is set for performing the approved treatment during step S37.
The treatment is completed during step S38 and the Final Payment Claim (FPC) form is filled out during step S39. It will be appreciated that the Final Payment Claim form, for many but not all insurance companies, is merely a subsection of the Predetermination form generated in step S29 (See the paper denoted P* in FIG. 1.); alternatively, the Final Payment Claim form could be yet another form supplied by the insurance company.
The Final Payment Claim form is then sent back to the insurance company with a copy of the signed Predetermination form during step S40. See task T7 in FIG. 1. The Final Payment Claim form enters the mail room as a paper form and the final processing begins during step S41. It will be appreciated that the processing of the Final Claim Form typically requires making several entries in the information stored on the mainframe computer 350 and may require the preparation of one or more forms needed to authorize payment of the final claim. However, since an attachment is not normally associated with the Final Claim Form, additional discussion regarding disposition of the Final Claim Form within the insurance company will not be provided.
Thus, the hybrid system under discussion is one that starts in the provider""s office when a patient is told that a PAC form is needed and continues until the procedure has been completed and a Final Payment Claim form has been submitted to the insurance company for payment. It will be appreciated that a myriad of problems and inefficiencies arise due to claim processing in accordance with the hybrid system. The principal problems are as follows:
1. All information needed to complete the PAC form has to be entered by hand. Moreover, all of the information on the PAC form is also manually transcribed in order to transfer the information from paper to the insurance company""s mainframe computer. Both of these manual data entry process steps are time consuming, very costly, and prone to human error;
2. The x-ray film and the text form are put together and then separated several times during the overall claim processing;
3. The hybrid system requires that a hard copy of the x-ray be sent to the insurance company. Generally, this x-ray is returned to the provider. Moreover, the requirement that the dentist provide the x-ray typically means that a duplicate x-ray has to be made by the dentist, which increases the dentist""s cost for the service. Oftentimes, the duplicate x-ray is of poor quality and cannot be read;
4. Because prior approval claim forms cannot be processed electronically, and because PAC forms make up half of all the claims that approximately 20,000 oral surgeons, periodontists, and orthodontists make each year, these 20,000 providers have no compelling reason to initiate electronic claims or Final Payment Claims;
5. The document identification number is affixed to the x-ray and the electronic text in two different processes, one physical and the other electronic. This leads to errors;
6. After the procedure has been completed, almost identical information may again have to be entered by hand in order to prepare the Final Payment Claim form;
7. While direct digital x-ray equipment is available, it is difficult to integrate a digital x-ray into the current hybrid claims processing system, i.e., these computerized images would first have to be transferred to film, which would, of course, negate the major advantage for using direct digital x-rays;
8. Some insurance companies would like to require that x-rays accompany all dental claims; they are prevented from doing so because of the high administrative overhead associated with handling hardcopy claims;
9. The patient has to obtain the PAC form from the insurance company or his employer. In either case, this causes the patient time, is an irritant, and imposes unnecessary delays on the delivery of medical care to the insured;
10. With the hybrid system, no pre-screening of the PAC form for errors is performed before the PAC form goes to the insurance company; and
11. Provider information, i.e., the dentist""s information, often has to be entered separately on each new PAC form that is submitted.
In short, the current method for handling PAC applications is a hybrid system somewhere between a Stage 1, a totally paper -based manual processing system, and a Stage 2 internally computerized insurance company processing system. It is part electronic and part hard copy. Also, each form must be handled twice, once as a hard copy and once as an electronic copy. This is the source of a great many of the above described problems. Moreover, the current hybrid method is costly. The process starting at the provider""s office, continuing through the insurance company and finally to the return of the Predetermination form to the provider has been estimated to cost $25. Furthermore, the whole process is filled with potential for error, frustration, wasted time and money.
The workflow for the filing and processing of a PAC form was described above with respect to the dental health insurance which was used, by way of example, to illustrate the circuitous process involved when a hard copy attachment is present. Other types of claims, or attachments, or different insurance companies might require slightly different steps. For example, instead of returning an attachment, as describe above, the attachment might need to be microfilmed and archived, or some of the information contained in the attachment itself might need to be entered into the mainframe. Regardless of these differences, there are similarities in the problems that arise in processing such claims.
In summary, in the insurance industry, payers and providers exchange a great amount of information, which, in general, falls into two categories:
1. Information flowing from the Payer to the Provider. It will be appreciated that this information can be further subdivided into additional types of information including, but not limited to information directly related to the Claim Application, e.g., content of the claim form or list of specified attachments needed to support a particular CPT code, general information, e.g., Preferred Provider List for specialists, etc., and responses to submitted claims, e.g., RFI on a claim sent.
2. Information flowing from the Provided to the Payer. It will be appreciated that this information will generally be limited to Completed Claim Applications, e.g., AIC forms.
It will be appreciated that the information specified by the payer as item (1) determines the information provided by the provider in item (2). It will also be appreciated that this information flow is further complicated by the fact that each of the various payers may have:
1. Differing Claims Information Requirements, i.e., the information each payer requires is unique to that specific payer;
2. Differing General Information, i.e., each payer has a respective unique set of preferred providers;
3. Dynamic Information Demands, i.e., the information identified immediately above changes over time; and
4. Different legacy system requirements, i.e., the provider generates a plurality of AIC forms, each going to a different payer in a payer specified format.
As discussed above, the information flowing from the provider to the payer can be in one of several forms, including:
1. Paper Claim Formsxe2x80x94These forms tend to have different content and to have the blanks for content arranged differently on the page. This leads to confusion and wasted time at the provider""s office in completing the forms.
2. Electronic Claim Formsxe2x80x94Because of the differing legacy computer systems and because of the confusion created by different forms, the current electronic solution takes the form of a rigid standardized electronic form based on truncated information. Stated another way, in order to optimize the cost savings of electronic forms, the payers are bound together in a rigid group where all must accept the limited information of a standardized electronic form and none can act independently to request more information be sent electronically.
3. General Informationxe2x80x94Information regarding preferred providers, etc., is currently available in hardcopy form. It will be appreciated that one hardcopy Preferred Provider List is very time consuming to use; the problem is exacerbated when many Preferred Provider Lists must be maintained. Even when this information is in digital form, there are still problems for providers because each payer has its own database and ways of searching for information within that database.
What is needed is an electronic claim form instantiated by a Standard User Interface (SUI) which allows each provider to complete and then electronically transmit claim forms, which differ from one payer to another, to all payers. What is also needed is a dynamic claim form which permits each payer the freedom to independently determine the information content of its electronic claim form and to change that information, at will, over time. It will be appreciated that this latter requirement could be provide while, at the same time, maintaining the single multi-payer solution including the SUI. Thus, each payer can specify and later modify the information that it wants from all providers, while each of the providers always see and fill in the same form. What is also needed is a dynamic claim form which allows an individual payer to be readily selected by the provider. It would also be desirable if the dynamic claim form could assist the provider in determining the information required by the selected payer. It will be appreciated that the enumerated desirable characteristics permits overall system coherence (interoperability) yet independence for each payer.
One purpose of the present invention is to create a coherent system that allows for the electronic filing, transmission, and processing of xe2x80x9cinsurance claims with attachments,xe2x80x9d and to thereby overcome the many deficiencies of the hybrid system claims processing methodology described above.
Thus, one object according to the present invention is to provide a PAC form processing system which minimizes the necessity of manual data entry. According to one aspect of the present invention, only about 40% of the information needed to complete the PAC form has to be entered by hand. According to another aspect of the present invention, the amount of information that has to be manually re-entered by an operator is essentially zero.
Another object according to the present invention is to provide a PAC application processing system which eliminates handling errors resulting in a mismatch between, for example, a PAC form and an associated patient x-ray. According to another aspect of the invention, mismatch errors are virtually eliminated since the electronic x-ray and the associated text are never separated; field data included in, for example, the PAC form is copied and transferred between the server and the mainframe computer systems inside the insurance company. According to yet another aspect of the invention, mismatch errors are virtually eliminated since no hard copy of the x-ray is ever sent to the insurance carrier.
Still another object according to the present invention is to provide a PAC application processing system which increases the number of service providers employing electronic claims systems to thereby reduce the overall claims processing costs. Since a PAC form can now be handled electronically in accordance with the present invention, electronic final payment claims become viable for approximately 20,000 additional dentists.
A still further object according to the present invention is to provide a PAC application processing system in which Document Identification Numbers, or some other method of uniquely specifying the PAC, are simultaneously associated with both the text and the x-ray by a single computer entry.
Yet another object according to the present invention is to provide a PAC application processing system which operates at lower cost. Cost efficiencies are readily achieved according to the present invention by eliminating the need to send a physical x-ray with the claim.
Another object according to the present invention is to provide a cost effective claim processing system wherein little or no information on either the PAC form or the Predetermination form has to be manually re-entered.
Still another object according to the present invention is to provide a totally digital PAC application processing system which can accommodate both text and digitized x-rays at low cost, thereby allowing insurance companies to require x-rays with all claims because such requirements will not significantly increase the processing cost associated with non-x-ray documented claims.
An additional object according to the present invention is to provide a totally digital PAC application processing system in which a dynamic claim form, i.e., the PAC form, which addresses the needs of all insurance carriers, is stored in the memory of the computer in every service provider""s office. Alternatively, this form could also be stored and accessed at an Internet website. This, in combination with a non-clearinghouse communications channel and having AIC system software at all of the insurance carriers, then eliminates the need for imposing industry-wide standards, such as ANSI ASC X12, for claim-related electronic transactions. The present invention allows each individual insurance company to obtain the information that it requires and to get that information in whatever format that insurance company prefers. Moreover, the ability to transmit the dynamic claim form and integrated attachment to an insurance carrier via a non-clearing house communications channel advantageously permits the transmission of other types of claims, including worker""s compensation claims, to the insurance carrier. In addition, it will eliminate the irritant of the patient or provider having to obtain a PAC form from a particular insurance company. Finally, it will give the provider xe2x80x9ctime of service notificationxe2x80x9d of the needs of the payer. This, in turn, will drastically reduce the rate of claim rejection by the payer with the attendant necessity of re-review of a claim by the provider.
Another object according to the present invention is to provide a totally digital PAC application processing system in which pre-screening of information entered into a PAC form, which is stored in the memory of the computer in the service provider""s office, is easily performed.
Yet another object according to the present invention is to provide a totally digital PAC application processing system in which provider information is automatically entered into each PAC form.
It will be appreciated that none of the above-identified objects need actually be present in invention defined by the appended claims. In other words, only certain, and not all, objects of the invention have been specifically described above. Numerous other objects advantageously may be provided by the invention, as defined in the appended claims, without departing from the spirit and scope of the invention.
These and other objects, features and advantages according to the present invention are provided by a standard graphical user interface (GUI) instantiated by computer software for generating a file from text data entered into selected ones of N fields in the GUI, wherein the selected ones of the N fields which accept text data are determined responsive to text entered into a first predetermined one of the N fields, and wherein N is an integer greater than 2. Moreover, the selected ones of the N fields is further limited responsive to text entry into a second predetermined one of the N fields. In an exemplary case, the first predetermined one of the N fields accepts a payer name while the second predetermined one of the N fields accepts a CPT code.
According to another aspect, the present invention provides combination of storage media storing computer readable instructions for permitting non-networked computers to cooperate synergistically including a first storage medium storing computer readable instructions for permitting a first computer system to generate a form including N fields, to receive textual data as field data in selected ones of the N fields, to assemble the field data and a corresponding digitized attachment into a first file, and to transmit the first file to a second computer system via a communications channel, a second storage medium storing computer readable instructions for permitting the second computer system to receive the first file via the communications channel, to display the corresponding digitized attachment on a second screen of the second computer system, and to transfer the field data to a third computer operatively connected to the second computer, and a third storage medium storing computer readable instructions for permitting the third computer system to receive the field data from the second computer, to display the field data on a third screen of the third computer system and to generate a second file including portions of the field data extracted from the first file. Preferably, the selected ones of the N fields accepts text data are determined responsive to text entered into a first predetermined one of the N fields, and N is an integer greater than 2.
According to yet another aspect, the present invention provides a method for operating a computer system including first, second and third computers, each of the first, second and third computers including a memory, an input device, and a display, respectively, the first and the second computers being connected to one another by modems and a common communication line, and the first computer including a digitizing device. The method advantageously includes steps for:
(a) retrieving a first form including N fields from storage in the first computer""s memory and displaying the first form on the first computer""s display;
(b) selecting M of the N fields responsive to text entry into a first predetermined of the N fields;
(c) writing first field data to the first form using the first computer""s input device;
(d) digitizing a patient""s x-ray to thereby generate a digitized x-ray;
(e) combining the digitized x-ray and the first form so as to generate an attachment integrated file;
(f) transmitting the attachment integrated file to the second computer;
(g) transmitting the first field data from the second computer to the third computer;
(h) generating a second form upon receipt of the attachment integrated file, the first and second forms containing at least a portion of the first field data;
(i) displaying the first form, the second form and an image corresponding to the digitized x-ray on respective displays of the third computer and the second computer;
(j) writing second field data to the second form using the third computer""s input device;
(k) transmitting the first and second field data corresponding to second form back to the first computer,
wherein M and N are both integers greater than 2.
According to a still further aspect, the present invention provides a combination of storage media which store computer readable instructions for permitting Mxc3x97(Nxc3x97R) non-networked computers to form a coherent system, including M first storage medium storing computer readable instructions for permitting each of M first computer systems to receive textual data as field data, to assemble the field data and a corresponding digitized attachment into a first file and to transmit the first file to a selected second computer system and a selected third computer system via at least one communications channel, N second storage medium storing computer readable instructions for permitting the selected second computer system of N second computer systems to receive the first file via the at least one communications channel, and to display the corresponding digitized attachment on a second screen of the selected second computer system, and R third storage medium storing computer readable instructions for permitting the selected third computer system of R third computer systems to receive the field data of the first file via the at least one communications channel, and to display the field data on a third screen of the selected third computer system. Preferably, M, N, and R are each a positive integer greater than one, the selected second computer system and the selected third computer are selected by one of the M first computer systems responsive to address information included in the field data in the first file, and multiple items in the field data is selected by diagnostic code included in the field data.
According to another aspect, the present invention encompasses a graphical user interface (GUI) instantiated by computer software for generating a file transmittable to a selected one of M recipients from text data entered into selected ones of N fields in the GUI, wherein the selected ones of the N fields which accept text data are determined responsive to text entered into a first predetermined one of the N fields, the computer software is updated as the respective file requirements of the M recipients change, and N is an integer greater than 2.
According to a further aspect, the invention provides a graphical user interface (GUI) instantiated by computer software for generating a file transmittable to a selected one of M recipients from text data entered into selected ones of N fields in the GUI, wherein the selected ones of the N fields which accept text data are determined responsive to text entered into a first predetermined one of the N fields, the format of the file is determined responsive to text entered in the first predetermined one of the N fields, and N is an integer greater than 2.
According to a still further aspect, the present invention encompasses a coherent computer system providing interoperability between a plurality of independent computers. Preferably, the computer system includes a plurality of first computers, each of the first computers comprising a first storage medium storing computer readable instructions for permitting the respective first computer to:
generate a form including N fields;
receive textual data as field data in selected ones of the N fields;
assemble said field data into a first file; and
transmit the first file to a selected one of a plurality of second computers via a communications channel; and
the second computers, each of the second computers comprising a second storage medium storing computer readable instructions for permitting the respective second computer to:
receive said first file via the communications channel, and
display said field data on a screen of the respective second computer.
Advantageously, in the coherent computer system, the selected ones of the N fields which accept text data are determined responsive to text entered into a first predetermined one of the N fields,
the selected one of the respective second computers is selected responsive to the text entered into the first predetermined one of the N fields, the computer readable instructions stored on the first computers are updated responsive to changes to the selected ones of the N fields generated by a respective one of the second computers, and N is an integer greater than 2.
According to yet another aspect, the present invention provides an electronic claim form instantiated by a Graphical User Interface (GUI) which permits each of a plurality of first users to complete and then electronically transmit N forms to N respective second users, wherein each of the N forms differs from the remaining N forms in terms of one of content and format.
According to still another aspect, the present invention provides a dynamic electronic form which permits each of a plurality of first users to: independently determine the information content of its respective electronic form, and freely change the information over time. Preferably, the electronic form presented to each of a plurality of second users is constant, irrespective of changes to the information content dictated by a respective one of the first users.
According to another aspect, the present invention provides a dynamic electronic form accessible via a computer which provides a first user with the ability to freely select a second user from a plurality of second users, and which assists the first user in determining, assembling, and transmitting information specifically required by the second user, wherein the dynamic electronic form maintains a constant appearance irrespective of changes to required information established by any of the second users.
These and other objects, features and advantages of the invention are disclosed in or will be apparent from the following description of preferred embodiments.